why there is no doctor: the impact of hiv/aids in the post-apartheid health care system of south africa

This is a series of posts based on the lengthy research paper that I completed as part of my “field experience” requirement for my International Relations major at James Madison College, as well as my Global Area Studies: Africa major and International Development specialization through the College of Social Science at Michigan State University. I was supported by the Young People For internship program as well as my friends and family. My field experience was completed as a three month long internship at Vumundzuku-bya Vana ‘Our Children’s Future’ (VVOCF) in the peri-urban settlement of Zonkizizwe, just south of Johannesburg. My tasks as an intern were to conduct health classes, run the HIV/AIDS Peer Educator courses, help with day-to-day programming, as well as assist in the nonprofit development and paperwork. The highlight of my work was organizing an HIV Testing Day with the clinics for the whole community. In all 80 people were tested in an area where stigma around HIV/AIDS and testing is very high. Please feel free to send comments and recommendations to help improve my work. Thanks!

i. Why are there No Doctors?
Academic Paper:
1. Introduction to an Epidemic
2. The Health System via Apartheid
3. Cleaning Black Spots of off a White Land?
4. High-Risk Migration Patterns
5. Scapegoating “tropical workers”
6. HIV/AIDS in South Africa
7. Denial is the First Step
8. What happened to Reconstruction and Development?
9. Post-Apartheid Health: the Burden Continues to get Heavier
10. Harsh Realities in Zonkizizwe (part 1)
11. Harsh Realities in Zonkizizwe (part 2)
12. Conclusion & Works Cited
13. Appendix A: Timeline of Health Care and HIV/AIDS in South Africa

why there is no doctor: scapegoating "tropical workers" (5)

(photo: At the Lesotho border)

As early as 1913, international migrant workers have been brought into South Africa to fill out the labor supply, especially in the mines (42). These workers were called “tropical workers” because they came from countries like Malawi and Mozambique that had more tropical climates and diseases. The mines faced a labor shortage starting in the 1930s and by 1934 over 2,000 “tropical workers” had been brought in on an experimental basis (43). The South African government had difficulties with “tropical workers” bringing in disease and spreading it before 1930 and so there was a certain stigma associated with international laborers. Early tropical workers were blamed with bringing tuberculosis and spreading it within the mines. However, working conditions in the mines and biological susceptibility were not taken into account. Regardless, tropical workers were associated with tuberculosis and that reasoning led the South African government to be wary about reintroducing tropical workers in 1934. The success of these workers and lack of increased disease inspired the South African government to lift the ban on hiring workers above the 22nd parallel in 1937 (44). With the lift of the ban, the numbers of tropical and international migrant workers increased significantly.

Tropical workers entering South Africa numbered 40,000 by 1948, the start of apartheid (45). Between 1988 and 1992, around 13,000 tropical migrant workers from Malawi were repatriated because over a two year period 200 of them had tested positive for HIV (46). The tropical worker who was scapegoated for the spread of tuberculosis was now labeled as the culprit for the spread of HIV to South Africa. Later it was understood that the South African mining industry was working on stabilizing its mining labor supply and HIV/AIDS was used as a way to clear out international migrant workers.

Nevertheless, the increase in numbers of tropical or international migrant workers to South Africa expanded the area where high-risk behavior related to HIV/AIDS could have an impact. The international migrant worker movements from the mines to their home countries and any locations in between likely contributed to the increased prevalence of HIV similar to studies that have proven the same for internal labor migrations. The reach of apartheid’s policies stretched beyond South Africa’s borders and contributed to the deepening of the HIV/AIDS crisis within the country as well as the southern African region.

42. Packard, Randall. White Plague, Black Labor: Tuberculosis and the political economy of health and disease in South Africa. University of California Press. 1989, 229.
43. Ibid, 230.
44. Ibid.
45. Ibid.
46. Chirwa, Wiseman Chijere. “Aliens and AIDS in Southern Africa: The Malawi-South Africa Debate.” The Royal African Society. African Affairs 97:53-79, 1998.

Coming next: HIV/AIDS in South Africa